Repositioning Maneuver for the Treatment of the Apogeotropic Variant of Horizontal Canal Benign Paroxysmal Positional Vertigo

Appiani, Giuseppe Ciniglio; Catania, G; Gagliardi, Mario; Cuiuli, Giuseppe

doi:10.1097/00129492-200503000-00022

Cited by 86 publications

(86 citation statements)

References 12 publications

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“…Several methods of physiotherapy have been advanced to relocate otolithic debris into the utricle in HC-BPV, which include a rolling of 180°towards the unaffected ear from supine to prone position [3], forced prolonged position [24,25], and barbecue rotation [17,18,24]. In apogeotropic HC-BPV, the therapeutic goal should be to detach the otolithic debris from the cupula or shift the debris from the anterior into posterior arm of the horizontal canal [1,8,24,29,30]. If successful, the detachment should result in immediate resolution of the positional vertigo and nystagmus, or in a shift of the debris into posterior arm of the canal, giving rise to a transition into geotropic HC-BPV.…”

Section: Introductionmentioning

confidence: 99%

Treatment of apogeotropic benign positional vertigo: comparison of therapeutic head-shaking and modified Semont maneuver

Kim

Jeong

et al. 2009

J Neurol

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Several methods of physiotherapy have been advanced for apogeotropic type benign positional vertigo involving the horizontal semicircular canal (HC-BPV). The aim of this study was to determine the therapeutic efficacies of the proposed maneuvers in apogeotropic HC-BPV. Using a prospective randomized trial involving seven nationwide dizziness clinics in Korea, we compared the immediate efficacies of head-shaking and modified Semont maneuvers in 103 consecutive patients with apogeotropic HC-BPV. We also determined an additional therapeutic benefit of mastoid oscillation while the patients without response to both maneuvers were performing the Brandt-Daroff exercise. Successful treatment was defined as resolution of positional vertigo and nystagmus, or as transition into geotropic HC-BPV. Results showed that head shaking was more effective than the modified Semont maneuver (37.3 vs. 17.3%, P = 0.02). However, therapeutic efficacy did not differ between the maneuvers after the initial non-responders switched over to the other maneuver (23.3 vs. 25.0%, P = 0.861). Mastoid oscillation provided no additional benefit while the patients without response to both maneuvers were performing the Brandt-Daroff exercise. Most positional vertigos resolved within a week (89.4%) irrespective of the treatment modalities applied and all showed resolution within 28 days. The head-shaking maneuver described here proved more effective than the modified Semont maneuver in treating apogeotropic HC-BPV. Mastoid vibration conferred no additional benefit during the Brandt-Daroff exercise.

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Section: Introductionmentioning

confidence: 99%

Treatment of apogeotropic benign positional vertigo: comparison of therapeutic head-shaking and modified Semont maneuver

Kim

Jeong

et al. 2009

J Neurol

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“…The roll test was done with the patient in the supine position with the head flexed 30° and rotated 90° in one direction, then returned to the starting position (head to zero degree), and the maneuver was repeated towards the opposite side. The treatment consisted in applying: Gufoni manoeuver 15,16 in eighteen patients (48.6%), the barbecue 360° manoeuver (BBQ) 17 , in twelve patients (32.4%), both maneuvers in four patients (10.8%); both maneuvers plus head shaking maneuver (HSM) 18 in one (2.7%); and HSM plus Gufoni maneuver in three patients. There were no specific criteria in the choice of maneuvers used in the treatment with the exception that in some patients, the Gufoni maneuver was chosen due to overweight or complaints of neck pain.…”

Section: Methodsmentioning

confidence: 99%

Horizontal canal benign paroxysmal positional vertigo: diagnosis and treatment of 37 patients

Maranhão

Filho

2015

Arq. Neuro-Psiquiatr.

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Benign paroxysmal positional vertigo (BPPV) is the most frequent type of vertigo 1,2,3 with prevalence between 10.7 and 64.0 per 100,000 population, and lifetime prevalence estimated of 3.2% in females, 1.6% in males, and 2.4% overall 1 . BPPV generally has the highest age distribution in the sixth decade of life 3,4 , with a prevalence approaching 9% among the elderly population 5 . It is characterized by brief, recurrent episodes of vertigo triggered by changes in head position. Its pathophysiology, so called the "vestibular stones, " concept, is either due to abnormal stimulation of the dome caused by free-floating otoliths within semicircular canals (canalolithiasis), or otoliths clinging in the dome (cupulolithiasis) 4,6,7 . The duration, frequency and intensity of symptoms, as well as the nystagmus phenotype, vary depending on the canal in question and the location of the debris within them. The idiopathic form is the most frequent and the average duration of episodic symptoms is about two weeks 8 . The right ear is usually more involved 9 . Eighty-six percent of affected individuals seek medical care but only 8% receive effective treatment 8 . When considering the frequency of affected semicircular canals, certainly for anatomical / positional reasons, BPPV of the horizontal canal (HC-BPPV) is four times less frequent than the posterior canal (PC-BPPV) 6,10 , but this frequency is increasing and currently, depending on the study, the recognition of HC-BPPV ranges from 10% to 42.7% 11,12 . Although the symptoms in HC-BPPV and PC-BPPV are similar, important 1 Instituto Nacional de Câncer, Departamento de Fisioterapia, Rio de Janeiro RJ, Brazil. ABSTRACTBenign paroxysmal positional vertigo (BPPV), the most frequent cause of vertigo is associated with high morbidity in the elderly population. The most common form is linked to debris in the posterior semicircular canal. However, there has been an increasing number of reported BPPV cases involving the horizontal canals. The purpose of this article is to highlight the clinical features, diagnosis, and treatment in 37 patients with horizontal canal BPPV; twenty-six with geotropic nystagmus, and eleven with the apogeotropic form. Treatment consisted of the Gufoni manoeuver in eighteen patients (48.6%), the barbecue 360° maneuver in twelve patients (32.4%), both manoeuvers in four patients (10.8%), both manoeuvers plus head shaking in one patient (2.7%), and the Gufoni maneuver plus head shaking in two patients. Cupulolithiasis patients were asked to sleep in a forced prolonged position. We obtained a complete resolution of vertigo and nystagmus in 30 patients (81.0%) on the initial visit.Keywords: benign paroxysmal positional vertigo, horizontal canal, dizziness, nystagmus, canalith-repositioning maneuvers. RESUMOVertigem posicional paroxística benigna (VPPB) é a causa mais frequente de vertigem e promove alta morbidade na população idosa. A forma mais comum está relacionada com otoconias no canal semicircular posterior. Entretanto, nos últimos anos identifica-se...

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“…7 Porém, novamente por sua facilidade, utilizando inércia e força gravitacional, a manobra de Gufoni para a variante ageotrópica da VPPB de canal lateral tem sido muito utilizada. 7 Na manobra de Gufoni para a variante ageotrópica da VPPB de canal lateral o paciente sentado de lado na maca é rapidamente lateralizado na direção do ouvido afetado, permanecendo nessa posição por dois a três minutos. Nessa posição, o canal lateral do lado afetado está em plano vertical e as otocônias no segmento anterior (braço curto ou braço ampular do canal) se deslocam em direção ao segmento posterior do canal.…”

Section: Manobras De Tratamento Para Vppb De Canal Lateralunclassified

“…Na maioria dos casos (66%), 7 transforma-se o caso na variante geotrópica da VPPB de canal lateral, sendo necessária em sequência a necessidade da manobra de Gufoni para variante geotrópica já descrita anteriormente.…”

Section: Manobras De Tratamento Para Vppb De Canal Lateralunclassified

Desvendando as manobras otoneurológicas

Carvalho¹

2015

Revista Hospital Universitário Pedro Ernesto

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31Resumo A vertigem postural paroxística benigna (VPPB) é provavelmente o diagnóstico mais comum em setores de otoneurologia de clínicas e hospitais. Embora, na maioria das vezes, tenha um bom prognóstico evolutivo, alguns casos podem durar semanas ou meses, gerando insegurança, risco de quedas e prejuízos laborativo e social. O desenvolvimento do tratamento da VPPB por meio de manobras de reposicionamento e liberação das partículas otoconiais encurtou o prazo de sua resolução, sendo esse enfoque terapêutico tratado aqui nesta revisão. Ao longo dos anos, diversos autores desenvolveram e aperfeiçoa-ram técnicas de manobras, com o objetivo de ampliar as opções terapêuticas nos diferentes tipos de apresentação clínica da VPPB. Vamos enfatizar nessa revisão as manobras de uso mais atual, ao mesmo tempo em que comentaremos essas diferentes apresentações clínicas. A literatura recente confirma a eficácia dessa modalidade de tratamento da VPPB, e o conhecimento de suas nuances é importante para um resultado satisfatório.Descritores: Vertigem; Nistagmo patológico; Terapêutica. Abstract Unmasking maneuvers in neurotologyBenign paroxysmal positional vertigo (BPPV) is probably the most common diagnostic found in hospitals and clinics which are specialized in the neurotology field. Although most of the times a good evolutive prognostic is reached, some cases could last for weeks or even months, generating insecurity, risk of falls as well as labor and social prejudice. The development of the treatment through repositioning maneuvers and the release of otoconia particles has shortened the length of its resolution, and this therapeutic approach is being discussed in this review. Over the years, several authors have developed and improved maneuvers techniques, with the objective of amplifying the therapeutic options spectrum on different types of clinical BPPV presentation. During this review, the most updated maneuvers will be emphasized as well as different clinical presentations. The most recent literature confirms the efficiency of this type of BPPV treatment, and the knowledge of its nuances is the key to a successful result.Keywords: Vertigo; Nystagmus, pathologic;Therapeutics. Desvendando as manobras otoneurológicas Resumen Descubriendo las maniobras otoneurológicasEl vértigo postural paroxístico benigno (VPPB) es, probablemente, el diagnóstico más común en sectores de Otoneurología de clínicas y hospitales. Aunque la mayoría de veces, tiene un buen pronóstico evolutivo, algunos casos pueden durar semanas o meses, generando: inseguridad, riesgo de caídas y prejuicios laborales y sociales. El desarrollo del tratamiento del VPPB por medio de maniobras de reposicionamiento y liberación de partículas otoconiales acorta el tiempo de su resolución, éste enfoque terapéutico es tratado en esta revisión. Con el paso del tiempo, diversos autores desarrollaron y perfeccionaron técnicas de maniobra, con el objetico de ampliar las opciones terapéuticas en los diferentes tipos de presentación clínica del VPPB. Destacamos en esta rev...

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Repositioning Maneuver for the Treatment of the Apogeotropic Variant of Horizontal Canal Benign Paroxysmal Positional Vertigo

Cited by 86 publications

References 12 publications

Treatment of apogeotropic benign positional vertigo: comparison of therapeutic head-shaking and modified Semont maneuver

Treatment of apogeotropic benign positional vertigo: comparison of therapeutic head-shaking and modified Semont maneuver

Horizontal canal benign paroxysmal positional vertigo: diagnosis and treatment of 37 patients

Desvendando as manobras otoneurológicas

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